Are Health Systems Ready for MACRA? Survey Reveals the Number One MACRA Concern and Varying Degrees of Readiness
Health systems are hanging back from implementing comprehensive strategies to comply with the Medicare Access and CHIP Reauthorization Act (MACRA), which will use 2017 as its first reporting year. But for those charging ahead, the news is mostly good, according to a new Health Catalyst®/Peer60 survey of 187 healthcare professionals who responded to an online survey in late 2016.
Click to View
Respondents included 37 CEOs and 94 other C-Suite executives, including CFOs, CIOs, CMOs, and CMIOs. They work for organizations ranging from some of the nation’s largest urban academic medical centers and integrated delivery networks to small, rural critical access facilities.
Understanding MACRA: Two Tracks and a Final Rule
MACRA consolidates and replaces a number of value-based reimbursement programs, including the Physician Quality Reporting System (PQRS), Meaningful Use, and the Value-Based Payment Modifier (VBPM). The new program has two tracks—one for physician groups still largely operating in the fee-for-service (FFS) realm, called the Merit-Based Incentive Payment System (MIPS) and those practices with the bulk of their business in alternative payment models (APMs).
Most practices won’t meet the high bar CMS has set for the APM track, and instead will be subject to MIPS rules, which offer the opportunity to earn up to an extra four percent (or lose up to four percent) on its reimbursement rates in 2019 (based on 2017 performance). The carrots and sticks ramp up to a potential nine percent gain or loss by 2022. In October, CMS issued the final rule on MACRA, making it easier to comply with minimal, partial reporting in the first year.
Health Systems’ Top Concern: Compiling MACRA Quality Measures
The heavy lifting required to track and compile MACRA measures for reporting to Medicare is top of mind for healthcare executives. When asked which MACRA-related activities “pose the greatest difficulties for healthcare organizations,” 74 out of the 187 respondents (40 percent) ranked “compiling metrics for regulatory reporting” as the biggest challenge. The next biggest headache identified by survey respondents—18 percent—was the problem of “adjusting to greater coordination between providers and patients.”
Ready or Not, Most Health Systems Expect to Participate in MACRA
Only 35 percent (65) of respondents to the Health Catalyst survey said “we have a strategy and are well on our way to being ready” for upcoming MACRA reporting, based on 2017 charges. Ready or not, most do expect to participate, with only 5 percent of those surveyed planning to opt out of participating in the program entirely. Most of those who will give MACRA a pass are doing so because they do not have sufficient Medicare charges to make the program worthwhile—for instance, physicians working with pediatric hospitals.
Progress on MACRA strategies was, surprisingly, slightly higher among small-and medium-sized hospitals, despite their relative lack of resources compared to large hospitals and health systems. Respondents who said they have a MACRA strategy for their employed providers but haven’t made much progress implementing it included just 26 percent (31) of small- and medium-sized hospitals compared to 33 percent (22) of large hospitals and health systems.
On the other hand, the number of respondents who reported they would participate in MACRA but currently have no strategy included 33 percent (39) of small- and medium-sized hospitals and 24 percent (16) of large hospitals and health systems. The reasons for a lack of strategy were varied, with the most common reason being that the organization was trying to figure out if providers could profit by participating in MACRA. Others said the work was too cumbersome, or they either had too little information on MACRA or they were overwhelmed with too much information.
Most Health Systems Believe Physicians Will Benefit from MACRA
Despite their relatively slow movement on MACRA, few hospitals reported being worried that the regulations would cost them money. Two-thirds of the 73 small- and medium-sized hospital respondents that reported having a MACRA strategy expect their employed physicians will either receive a bonus or break even, whether or not they have made progress on their strategy. Only one small hospital respondent said providers expected to receive a penalty, while nine said they weren’t sure.
The numbers were similar for large hospitals and health systems. Of the 45 respondents from large hospitals and health systems who said they have a MACRA strategy, 36 percent (16) expected their affiliated physicians to earn a bonus while 31 percent (14) said they expected physicians to break even. Just one large hospital expected their physicians to receive a penalty, while seven weren’t sure whether they would benefit or not.
The Bottom Line: Health Systems Are Marching Ahead with MACRA
Many health systems have hit the pause button on MACRA due to a combination of factors, including its complexity, the newness of the final rule, and uncertainty about whether the new Administration will make further changes. But those marching ahead are finding that compliance is likely to benefit their organization. The bottom line is that systems can choose which measures to report from their 2017 data, even if they haven’t finalized their MACRA compliance plan, and it’s likely worth their time.
Would you like to use or share these concepts? Download this MACRA presentation highlighting the key main points.